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The Civil War in 1863: Hammond's Last Year

Books and Documents > The Army Medical Department 1818-1865

CHAPTER 10

The Civil War in 1863: Hammond's Last Year

The appointment in 1862 of a vigorous, ambitious young medical officer as surgeon general and his encouragement of new approaches to Medical Department problems held out great promise for 1863. Under the guidance of William Hammond the Department was already rapidly recovering from the initial shock inflicted by the Civil War's unprecedented demands and taking the steps necessary to evacuate and care for thousands of sick and wounded soldiers. Failing to appreciate the serious danger posed by his strained relationship with Secretary of War Stanton, Hammond apparently assumed that 1863 would be but the first full year of a long and successful career as surgeon general.

Administration of the Medical Department

In spite of Hammond's confidence, the surgeon general's position was already beginning to deteriorate in the spring of 1863. Stanton was quite willing to manipulate events to effect the surgeon general's departure from office, and Hammond played into Stanton's hands by his tactless management of the explosive matter of the Army's use of calomel and tartar emetic as medicines. Hammond considered these drugs too dangerous for everyday use, but his removal of both from the supply table in May caused a great furor, despite the fact that he did permit special requests for either drug when a need could be established. At least one surgeon maintained that he continued to use both items as before. The clamor that Hammond's order caused thus seems out of proportion to the step taken, but the discussion of the matter ranged far and wide. Some agreed with the surgeon general and called his order "judicious, and even necessary," but many physicians were furious that Hammond would presume to tell other doctors what they could or could not prescribe. The potential for misuse was no excuse, they said, for barring tartar emetic and calomel from the supply table.1

Hammond's elimination of calomel and tartar emetic from the supply table probably cost him supporters at a crucial time. His position was rapidly deteriorating as

1Quote, "Removal of Calomel and Tartar Emetic," American Medical Times 6 (1863):297; Blustein, "Hammond," pp. 95-97; MSH 3, pt. 1:965; M. Goldsmith, "How to Get Supplies for the Sick and Wounded of Our Army," Sanitary Reporter 1 (1863):33; "Calomel and Tartar Emetic in the Army," American Medical Times 6 (1863):299; Gert H. Brieger, "Therapeutic Conflicts and the American Medical Profession in the 1860s," Bulletin of the History of Medicine 41 (1967):220-22; Ltrs, Byrne to Mansfield (2 Mar 1863) and SGO to "Dear Sir" (12 Jun 1863), both in RG 112, entry 2, 34:322 and 35:199, respectively; "Circular No. 6," Transactions of the American Medical Association 14 (1863):29-33.


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1863 came to a close, and Stanton continued to manipulate events to hasten his subordinate's demise. In the spring of the year, Stanton apparently refused to allow Hammond to travel west to investigate complaints about the work of the Medical Department there. In the summer, after appointing a commission headed by one of Hammond's personal enemies to investigate the department, the secretary of war relieved Hammond of his duties as surgeon general and sent him on an inspection tour to the South and West, appointing Joseph K. Barnes, who would be the next surgeon general, to act as head of the Medical Department. Barnes formed a close friendship with Stanton shortly after reporting for duty in Washington in mid-1862 and had already received two promotions in 1863.2

When Hammond set out on his journey in September, Stanton was almost ominously cordial. In early December, the Secretary of War found grounds for reprimanding Hammond, who responded not by resigning under fire, as his predecessor had done, but by asking for either a court-martial or a board of inquiry. He also asked for permission to return to Washington, where Stanton had, in Hammond's absence, been working to end his tenure as surgeon general. Stanton denied the request, but Hammond's health produced a solution to his problem, as it had in 1860. A few days before Christmas, after falling on the steps of a Nashville hospital and striking his head and back, Hammond suffered a temporary paralysis of both legs below the knees, an injury that he used to justify his return to Washington, where he could more easily deal with Stanton's attack.3

Under the circumstances, it is not surprising that Hammond's relationship with Stanton continued to affect adversely some of the surgeon general's favorite projects. Even though, early in 1863, Hammond was completely prepared to open his postgraduate Army Medical School, for example, and had determined which surgeon would teach each course, in the early fall and after the briefest of inspections, Stanton refused to approve the start of classes. On the other hand, when Hammond established successful laboratories for the Medical Department as part of its purveyance operations, and even Barnes, who was not given to praising either Hammond or Hammond's accomplishments, praised them, Stanton did not close them down. Although no attempt was made at these facilities to compound all the medicines the department used, by the end of 1863, after less than a year in operation, the laboratory in Astoria, New York, was making eighty-three of the items on the supply table. With the aid of the laboratories, Hammond could stockpile drugs, thus sparing the Army the effects of shortages and the resultant fluctuations in prices. Surprisingly, Army laboratories never manufactured quinine, despite the fact that the process of making it was relatively simple and the variations in its price quite marked. They tested quinine, however, and any other item susceptible to adulteration. The operations of the three facilities at Astoria,

2Brieger, "Therapeutic Conflicts," p. 220 n. 1; WOR, ser. 1, 30, pt. 3:245; WOR, ser. 3, 3:1199; Strong, Diary, p. 306; James M. Phalen, Chiefs of the Medical Department of the United States Army, 1775-1940, Army Med Bull No. 52 (Carlisle Barracks, Pa.: Medical Field Service School, Apr 1940), p. 48. Unless otherwise indicated, all material on Hammond's problems with Stanton is based on Blustein, "Hammond," pp. 102-05, and Maxwell, Sanitary Commission, pp. 234-37.
3Strong, Diary, pp. 359, 394; Louis C. Duncan, "The Days Gone By: The Strange Case of Surgeon General Hammond," Military Surgeon 64 (1929):109; WOR, ser. 1, 31, pt. 3:485.


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Philadelphia, and St. Louis resulted in a considerable savings for the Army during the course of the war from 1863 on. The laboratory at Philadelphia alone was credited with saving more than $75,000 from 1863 through 1865.4

Stanton's distrust for Hammond's projects did extend to the Army Medical Museum, which he apparently convinced the president was merely "a monument to General Hammond." But Barnes again found himself agreeing with the beleaguered surgeon general. Upon assuming the responsibilities of the head of the Medical Department in the fall of 1863, Barnes encouraged medical officers to continue sending in interesting specimens. More than 1,300 items had already arrived in Washington by I January 1863, and the Medical Department employed one man to serve as a water colorist and another as a "bone artist" to further the work of the museum.5

The best proof that Hammond's difficulties stemmed more from his personality and conflict with Stanton than from his management of the Medical Department was Barnes' continuance of Hammond's policies and, with the exception of the ill-fated medical school, Barnes' support of Hammond's favorite projects. The Medical Department worked without Hammond's hand at the helm as it had when he was there, and the furor that would engulf him affected the sick and wounded very little.

JOSEPH BARNES. (Courtesy of National Library of Medicine.)

Regardless of who was at the helm, the major concern of the Medical Department was always the day-to-day care of sick and wounded. With soldiers joining the Army by the thousands, the number of sick for whom the Medical Department was responsible grew rapidly. This increase was not unexpected, since new troops were always vulnerable, and epidemics traditionally followed their entry into military service. Malaria was so common, however, that its occurrence was taken for granted. It was generally treated in the field unless the patient was also ill with some other disease. Possibly because those who had contracted such diseases as typhoid fever in earlier years had become immune, but perhaps also because of improved sanitation, the disease rate in the category of contin-

4MSH 1, pt. 3:965; Ltrs, A. K. Smith to SGO (14 Sep 1863), and Barnes to Stanton (17 Sep 1863), both in RG 112, entry 12; George W. Smith, Medicines for the Union Army: The United States Army Laboratories During the Civil War (Madison, Wis.: American Institute of the History of Pharmacy, 1962), pp. 14-15, 37, 42, 60-61; Brinton, Memoirs, pp. 259-60.
5First quote, Maxwell, Sanitary Commission, p. 237; Daniel S. Lamb, "History of the Army Medical Museum," Military Surgeon 53 (1923):99, second quote from p. 98; Ltr, Earnest Goodman to J. F. Day, C. H. Lord, and D. H. Strickland (24 Apr 1863), Ms fB50, NLM; Schullian and Rogers, "National Library," p. 9.


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ued fevers was actually dropping. A breakdown of fevers into specific disease categories recognizable today was rendered particularly difficult by the invention of a new entity, typho-malarial fever, which may have been typhoid, malaria, both, or neither. Yearly statistics for diarrhea and dysentery, still the most common afflictions, could be misleading for, unlike typhoid, they could be both chronic and recurrent. For this reason cumulative figures tended to exaggerate the number of men who were actually ill with these problems over a twelve-month period. The figures for 1862 and 1863, however, do suggest a marked increase in the total number of typhoid sufferers and a significant upward trend in the acute form of this so-called malady. Scurvy cases were also on the increase, and given the nature of the soldiers' diet, it is entirely possible that many more than the figures suggest were suffering from subclinical scurvy, or in other words, the more subtle effects of a vitamin C deficiency.6

To care for those who were seriously ill as well as for those who had been severely injured, the number of general hospitals serving the Army increased from 151 sheltering fewer than 59,000 patients as reported in the annual report of 1862 to 182 the following year, with 84,472 beds. Not all of the beds by any means were in use at all times, since many had to be available to accommodate thousands of new patients after major battles. Many of the institutions of 1862 failed to survive through 1863; ten were closed in 1863 in Philadelphia alone as new facilities replaced the old. Hammond continued to place patients as near their homes as possible. While many hospitals were located in such major eastern cities as Philadelphia, New York, Boston, Baltimore, and Washington, others could be found throughout the Midwest, often along the Mississippi and its tributaries, where they could easily be reached by steamer. Still more were located at least temporarily near major battlefields, from Gettysburg, Pennsylvania, to Vicksburg, Mississippi.7

Moving ever larger numbers of patients to hospitals made necessary a more sophisticated approach to evacuation. Much attention was devoted in 1863 to new designs for hospital cars, ambulances, and litters. Boards of medical officers met to consider these new designs, and the quartermaster general himself was invited to inspect a new railroad car. Enthusiasm for a prototype led to the building of more cars on the basis of various designs inspired by civilian organizations, and to their eventual use on runs to such cities as Philadelphia, Baltimore, and New York, as well as Harrisburg, Pennsylvania, and Louisville, Kentucky. A new type of ambulance, a four-wheeler named for Tripler that could carry ten men, was also developed, but its usefulness was limited by the fact that it was so heavy that four horses were required to pull it.8

Keeping track of the patients who went in and out of this network of hospitals was difficult. Letterman had developed detailed forms to facilitate the submission of detailed reports. In practice, however, it

6MSH 1, pt. 1:147, 297, 452, and pt. 3:190-91, 193, 199; Smith, "Typhomalarial Fever. I, " pp. 182, 220, 287-321.
7War Department, SGO, Annual Report, 1862, p. 5 and 1863, p. 3; WOR, ser. 3, 2:389, 3:964-65; Ltrs, Hammond (Ind, 14 Mar 1863), RG 112, entry 2, 34:381; John Campbell to Barnes (2 Dec 1863) and McDougall to SG (4 Jul 1863), both in RG 112, entry 12.
8MSH 2, pt. 3:928, 948-49, 959-60 n. 1, 968; "Hospital Cars," Sanitary Reporter 1 (1863):30; USSC, Documents 2, no. 75:6; Turner, Victory Rode the Rails, p. 302.


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TRIPLER AMBULANCE, from illustration in Medical and Surgical History.

proved impossible to keep detailed accounts of the treatment, condition, and location of each patient from the moment he entered the care of an Army surgeon until he was discharged and to move these documents with the patient as he was evacuated and transferred from place to place. Overworked Army surgeons could not guarantee that detailed records would be ready to accompany the wounded when they were moved on short notice. A board that met late in 1863 to consider the problem devised a system calling for registers to be kept at each facility and turned in to the Surgeon General's Office, where the files from various institutions would be compared to eliminate duplications.9

The word evacuation is associated primarily with the wounded, but the sick continued to form the major part of the Medical Department's burden. Efforts to keep the unhealthy from entering the Army in the first place were intensified in 1863, and penalties were set for surgeons who were less than strict in this regard. Other approaches to the prevention of disease involved improved sanitation and hygiene and closer attention to the soldier's diet. The medical officer was handicapped, however, by the fact that he could only advise concerning the prevention of disease.10

The conviction that improper cooking, which usually meant frying, caused much

9Brinton, Memoirs, pp. 249-52.
10"Responsibility of the Army Surgeon," Sanitary Reporter 1 (1863):28; U.S. Provost Marshal General, The Medical Part of the Final Report Made to the Secretary of War (Washington: Government Printing Office, 1866), pp. 3-4, 11.


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AMBULANCE DRILL. (Courtesy of Massachusetts Commandery Military Order of the Loyal Legion and the U.S. Army Military History Institute.)

illness led to an attempt to make both medical and line officers responsible for culinary efforts. More worthwhile were efforts to guarantee that the soldier was offered an adequate amount of fruits and vegetables. Many line officers, however, failed to recognize the symptoms of scurvy or to realize how, even in its early stages, it could undermine the strength of their men. Because of their failure to understand the importance of potatoes to the health of their commands, officers sometimes casually helped themselves to supplies intended for the troops. Staff officers might thus appropriate 25 barrels out of every 100 for their personal use and that of their families and servants. Since another 25 might be siphoned off at the corps level and still more disappear as the shipment descended through the division and brigade levels, the men might receive none, even when authorities at the highest levels believed that the troops were adequately supplied. Hospitalized soldiers were not completely dependent upon the Commissary Department, which was responsible for supplying food to the troops in the field, because the Medical Department's purveyors supplied medicines as well as delicacies, which they continued to obtain from such organizations as the U.S. Sanitary Commission.11

Although otherwise few complaints

11H. A. Warriner, "Vegetables, Humanity, Patriotism" and "The Condition of the Army of the Cumberland in the Spring of 1863- The Aid Rendered by the Commission," both in Sanitary Reporter 1 (1863):92 and 2 (1864):153, respectively; John Ordronaux, Hints on Health in Armies for the Use of Volunteer Qfficers (New York: D. Van Nostrand, 1863), p. 63; Grace, Manual, pp. 75-76; John Gardner Perry, Letters From a Surgeon of the Civil War (Boston: Little, Brown & Co., 1906), p. 129.


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about supplies developed during 1863, problems relating to the caliber of the surgeons who worked in the Army continued. States still administered the exams for surgeons attached to volunteer regiments, and medical boards that convened to look into questions of competence might weed out two-thirds or more from among them. The dismissal from the service of doctors who were deemed unqualified contributed, however, to a shortage of physicians at a time when volunteer regiments still might report for duty without their full complement of medical officers. Surgeons were also needed to serve the new black regiments being formed, but they were recruited specifically for this duty rather than chosen from among those already recruited, and few were enthusiastic about the assignment. They were required both to be graduates of orthodox medical schools and to submit to the scrutiny of a medical board, but since few came forward, the hospital care of blacks often devolved upon stewards appointed to act as assistant surgeons. Black army surgeons were few and not always well received.12

Nurses, like doctors, were often overworked, especially in the West, and confusion over who would pay contract nurses left many without wages for weeks early in the year. The hardships they might have to endure were apparently unappreciated, for their pay was reduced from $20.50 a month to $13, plus a $3-a-month allowance for clothing. An order issued in the fall of 1863 permitted the surgeon general to appoint female attendants without consulting Dorothea Dix. Although this power, which could be delegated to hospital directors, was designed for use when acute shortages made it desirable that appointments be made as rapidly as possible, it also enabled the department to bypass Dix at any time that the surgeon general desired to do so. The order, which also required that no more than one nurse be assigned to every thirty beds, emphasized that women nurses were under the exclusive control of the senior medical officer of the hospital in which they served and that he could assign them their duties as he wished and dismiss them for incompetence or disobedience.13

The establishment of an official organization in 1863 to manage Negro units would lead before the war's end to the enlistment of more than 186,000 blacks and required planning for the medical care of their sick and wounded. Since authorities apparently believed that public opinion would not permit the sharing of the same facilities by both blacks and whites, special hospitals had to be set aside for the use of this new class of recruits, and black male and female nurses were hired under contract for a maximum of $10 a month to work in them.14

The shortage of nurses had already led to use of convalescents in hospitals, but in 1863 the Army took steps to assign those who were chronically ill or permanently crippled to work in these facilities. General

12"Responsibility of the Army Surgeon," Sanitary Reporter 1 (1863):28; Ltr, Hart to his wife (1 Feb 1863), in Correspondence and Diary, Ms C 146, NLM; Cir (2 Oct 1863), RG 112, entry 2, 36:155; Ltrs, Letterman to SG (8 and 13 Jan, 11 Mar, and 21 Sep 1863) and Israel Moses to SG (1 May 1863), all in RG 112, entry 12; Briggs, Civil War Surgeon, p. 117, Benjamin Quarles, The Negro in the Civil War (Boston: Little, Brown & Co., 1953), pp. 203-04.
13Forman, Western Sanitary Commission, p. 27; Grace, Manual, p. 86; Ltrs, Cuyler to Hammond (20 Jan 1863), B. Choate to John Carpenter (26 Jan 1863), and Head to Hammond (28 May 1863) and Cir, Magruder (23 Apr 1863), all in RG 112, entry 12; "Surgeon Meylert's Letter Continued," Sanitary Reporter 1 (1863):79.
14Ltrs, Magruder to SG (14 Apr 1863) and Suckley to SG (21 Nov 1863), and Cir, Magruder (23 Apr 1863), all in RG 112, entry 12; "Surgeon Meylert's Letter Continued," Sanitary Reporter 1 (1863):79.


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orders now required that invalids capable of light duties be mustered in detachments for work as hospital attendants, clerks, cooks, and guards. Many of the men so assigned were apparently the victims of chronic diarrhea or general weakness resulting from wounds or disease, but occasional nurse-invalids were men who had deliberately injured themselves, cutting off their own thumbs, for example, in what would, with the creation of the Invalid Corps, prove a futile attempt to avoid further military duty.15

Care of the Sick and Wounded in the East

In early January 1863, the Army of the Potomac was still reeling from the disaster at Fredericksburg just a few weeks earlier. Anticipating renewed hostilities, General Burnside established a medical facility nearby at Aquia, hoping thereby to avoid sending his sick back to general hospitals when his army advanced. When heavy rains and flooding forced him to abandon his campaign, he broke up the establishment at Aquia, sent the seriously ill back to Washington, and set up regimental hospitals to care for those with minor ills. For patients who could not be cared for in these small facilities, Jonathan Letterman as Burnside's medical director formed division hospitals wherever needed within each corps, thus providing his medical officers with experience in running such organizations.16

As they settled down near Falmouth, just north of Fredericksburg, in late January, the 120,000 men of Burnside's command were considered to be on active field duty rather than in winter camp. Since the Army provided them with no structures for shelter except inadequate tents, the men often dug shallow pits in the "wide-spreading sea of mud and mire," erecting log huts over these foundations and covering the logs with either tents or brush and mud. The Medical Department deplored this custom, but many regimental commanders appeared to be little concerned about the health and welfare of their men. Nevertheless, the sick rate among veterans initially held at 5 percent, and the rate for the Army of the Potomac as a whole, including fiftysix new regiments, was 8 percent. Letterman considered this record good under the circumstances, although he added that new recruits seemed to be suffering with unusual frequency from venereal diseases and hernia.17

At the end of January, when he relieved Burnside, Maj. Gen. Joseph Hooker was much concerned with the health of his new command, since diarrhea, scurvy, and a fever that was probably typhoid afflicted many. Enlisted men were receiving very little of what Letterman considered to be the ample amounts of vegetables shipped to them. In early February, however, after Hooker himself expressed his determination to have the troops receive an appropriate diet, fresh bread and vegetables were issued. Letterman believed that the improved diet, together with better sanitation and greater care with cooking, was responsible for an improvement in health by April the overall sick rate stood at 7 per

15MSH 3, pt. 1: 2 8; Paul Fatout, ed., Letters of a Civil War Surgeon (West Lafayette, Ind.: Purdue University Studies, 1961), pp. 57-58; Roberts Bartholow, A Manual of Instructions for Enlisting and Discharging Soldiers (Philadelphia: Lippincott, 1863), pp. 216-17.
16Unless otherwise indicated, all material on the medical care given the Army of the Potomac is based on Letterman, Recollections.
17Quote from Letterman, Recollections, pp. 102-03; Ltr, Letterman to SG (15 Jan 1863), RG 112, entry 12.


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cent. The rate of diarrhea-like ills had dropped from 5.4 percent in February to 3.4 percent, fevers were being encountered less frequently, and even the able-bodied were stronger and more vigorous.18

Improving the physical condition of the troops was but part of the preparations Letterman made for the campaign to come. Although an Army-wide reorganization had removed the District of Columbia from the control of the commanding general of the Army of the Potomac and thus the general hospitals of Washington from the control of its medical director, Letterman's hands were still full. He soon found it necessary to appoint first one and then a second medical officer to assist him by acting as inspectors for the Army of the Potomac. In addition, he issued orders to each corps medical director to appoint a surgeon to serve as medical inspector for his unit. Letterman also used the winter to establish medical boards to examine medical officers charged with incompetence.

Many new regiments had joined the Army of the Potomac since the preceding autumn, and in early April Letterman outlined once again how he wished the Medical Department under him to operate during battle. He also issued a call for a private from each company to report for ambulance duty wearing a green badge to identify him as a member of the ambulance corps and pointed out that all attendants below the rank of sergeant must turn in their arms before the start of battle. Letterman's desire to keep as many patients as possible in field hospitals intensified the need for a "regularly trained Corps of Hospital Attendants," but he never succeeded in establishing such an organization.19

Before Hooker's army started out for what would be known as the battle of Chancellorsville, his medical director set up tent hospitals along the railroad from Fredericksburg to the depot at Aquia. Here the wounded could remain with their comrades, at the same time providing experience in postoperative care for Hooker's surgeons. Organized by division, but grouped by corps, these facilities were, in his opinion, "abundantly supplied with officers, nurses, cooks, medicines, etc.," so abundantly, in fact, that he reportedly told Hammond that he did not want to have any civilian physicians and nurses sent to the field. An assistant surgeon in the Army of the Potomac, however, later complained about the lack of "trained & disciplined nurses." The tent hospitals were located near one another, so that one line officer, appointed at Letterman's request, could serve as both quartermaster and commissary for all. Since he strongly believed that "life in a General Hospital tends to destroy the good qualities of a soldier," when the army marched, Letterman left 8,000 sick behind in the tent hospital, still under the care of their own surgeons, rather than sending them back to general hospitals.20

Two factors, both beyond the control of the Medical Department, complicated the care of the wounded at Chancellorsville.

18Strong, Diary, p. 321; Huston, Sinews, p. 224; Rpt. (filed with Ltr, Letterman to S. Williams, 4 Apr 1863), RG 112, entry 12.
19Quote from Ltr, Goodman to McNulty, Ms fB50, NLM; GO (no. 13, 5 Apr 1863) and Ltr, Letterman to "Dr." (12 Apr 1863), both in Ms fB50, NLM; Duncan, "The Bloodiest Day in American History-Antietam," in Medical Department, pt. 5, p. 37; Bennett A. Clements, Memoir of Jonathan Letterman, M.D. (New York: G. P. Putman's Sons, 1883), p. 18.
20First and third quotes, Letterman, Recollections, pp. 113 and 143, respectively; second quote, MSH 1, app.:138; Clements, Memoir, pp. 13-14; Ltr, Letterman to SG (15 Jun 1863), RG 112, entry 12; see also Letterman, Recollections, p. 142.


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Defeat caused hospitals near the battlefield to be repeatedly threatened with capture (the enemy took and later paroled almost 1,200 wounded). Moreover, the rapid pullback of troops forced Letterman to evacuate the wounded over the long, rough twenty-five miles to the corps hospitals, rather than use facilities closer at hand. In addition, evacuation was made more difficult by Hooker's orders, which prevented many wagons, including those with medical supplies, and all but two ambulances per division from crossing the Rappahannock River with the units moving on Chancellorsville. No stretchers or stretcher bearers were permitted over the river until late on 30 April, by which time shelling had forced medical officers to abandon at least one hospital, and patients had, of necessity, been carried on litters improvised from blankets. Ironically, in a battle where many hospitals with their patients often had to be moved, the Medical Department was not as well prepared as it usually was for evacuation, but Letterman believed that the moves of the hospitals were, under the circumstances, well managed. After the battle was lost, it was only with difficulty that he was able to move enough ambulances across the river to return casualties to the north bank and to the corps hospitals. The approximately 9,500 wounded from Chancellorsville then traveled by train along the single track to Aquia, whence about 2,000 went by boat to Washington.21

The care of his patients who had been captured by the enemy also concerned Letterman. Nineteen physicians had been taken prisoner with them. Encouraged by General Robert E. Lee, Letterman sent twenty-six more medical officers and five wagonloads of medicines, blankets, and hospital stores through the lines. A week after the battle, Lee gave his permission for Union ambulances to come through the lines to pick up Union wounded, in so doing sparing these men the discomforts and dangers of a transfer from Confederate to Union vehicles at some halfway point. All captured Union wounded were back within Union lines by 15 May.22

Letterman believed that his surgeons had, on the whole, acquitted themselves well at Chancellorsville and pointed out that three had been wounded in action, two severely. A volunteer surgeon, however, maintained in a letter that "many of the Medical men behaved badly-ran off over the river in the first day's fight and never came back at all." Only a few lines later, however, he admitted that some of those who ran off did indeed come back, but added that they had consumed "the Stimulants sent over the River by the Medical Director for our sick." This medical officer may have been inclined to embroider his story a bit, but he was not the only one to raise questions about Letterman's estimate of the situation at Chancellorsville. Hooker reportedly ordered that the number of casualties not be revealed, and, lacking information, Stanton had Hammond send John Brinton to the Chancellorsville area with the secret mission of gathering information on the number of wounded, while ostensibly obtaining specimens for the Army Medical Museum.23

In his memoirs, Letterman reported that 9,518 men were wounded at Chancellorsville. Given the difficulty of obtaining accurate figures under the circumstances, his data compares well with that reported in

21Fatout, Letters, pp. 59-60; MSH 1, app.:124-26, 128-30,135,137-38.
22WOR, ser. 1, 25, pt. 2:432, 465-66.
23First and second quotes, Fatout, Letters, pp. 60 and 64, respectively; Brinton, Memoirs, pp. 233-35.


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the War of the Rebellion collection, which states that 9,759 officers and men were wounded and 1,606 killed. Brinton, however, after noting that one could safely assume four to five men wounded for every one killed, estimated that the total number of casualties was about 23,000, a figure far higher than that given by his contemporaries, although his memoirs do not reveal how he arrived at this figure.24

By mid-June, when Army of the Potomac patients were on their way to facilities in Aquia and Washington, the able-bodied were marching north under Hooker, following Lee, who was invading Maryland. Fortunately, the health of the Army of the Potomac was still generally good, for the weather was hot and the troops were pushed to cover twenty-five to thirty miles at a time, even when this meant marching at night. Water was scarce, and men collapsed and died from heat and stress. By the time they reached Pennsylvania, they were "much exhausted and but illy prepared to bear up under the shock of wounds." Hooker, however, had decreased the number of wagons allowed to supply the Medical Department's needs. During the last part of this ordeal, rain turned the dust to mud, and supplies were often abandoned along the roadside. It was fortunate that following the troops were Sanitary Commission wagons, and that their supplies were frequently replenished along the way.25

Although battle was expected almost momentarily, Hooker resigned as commanding officer of the Army of the Potomac on 28 June, to be replaced by Maj. Gen. George G. Meade. In his determination to keep open roads to his rear, Meade further complicated supply problems for his medical officers by issuing orders that resulted in hospital supply wagons being kept well back from the battlefield. A medical officer returning from Washington with supplies was also ordered away from the battlefield on 2 July. As a result of these difficulties, although the fighting at Gettysburg finally ended on 3 July, tents were not generally available until two days later. Most medical officers had to rely entirely on the small medicine wagons that routinely accompanied ambulances in the field. One corps had in some unexplained way escaped the restrictions placed on the rest of Meade's army, however, and its experiences suggest what could have been done had the rest of the army not been handicapped. Its normal complement of hospital supply wagons was allowed to accompany it from Virginia and none had been held back from the battlefield. Thus equipped, XII Corps medical officers were able to evacuate their wounded from the field, bathe, dress, and feed them, all within six hours of the end of the battle.26

Meade's restrictions complicated supply at Gettysburg, but ambulances worked freely. According to Letterman, of the more than 14,000 wounded, none who were within Union lines were left on the field, even though the 650 officers and 3,000

24 Brinton, Memoirs, pp. 234-35; WOR, ser. 1, 25, pt. 1: 192.
25Quote from [Justin Duineill], Medical Report of the Second Corps at the Battle of Gettysburg, Ms C129 (hereafter cited as Duinell Medical Report), NLM; Frederick Law Olmstead, "Preliminary Report of the Operations of the Sanitary Commission With the Army of the Potomac, During the Campaign of June and July, 1863," Sanitary Reporter 1 (1863):49. Unless otherwise indicated, in addition to Letterman's Recollections, all material of the Gettysburg campaign is based on Duncan's "The Battle of Fredericksburg" and "High Tide of the Confederacy- Gettysburg," both in Medical Department, pts. 6 and 7, respectively, and on MSH 1, app.: 141-47.
26Clements, Memoir, p. 12; William Warren Potter, Reminiscences of Field-Hospital Service With the Army of the Potomac (Buffalo: Buffalo Medical and Surgical Journal, October and November 1889), pp. 15-16.


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GENERAL SICKLES, LEG. (Courtesy of Armed Forces Institute of Pathology.)

drivers and stretcher-bearers of the ambulance corps had to work under fire, five of its members being killed and seventeen wounded. In bringing out the 12,000 whom the ambulances could reach, eight vehicles were damaged and a number of horses either killed or wounded. Nevertheless, since this battle lasted three days, the work of the ambulance corps was not as intense as it had been at Antietam and no serious difficulties developed.27

Although the placement of supply wagons far to the rear did not affect evacuation, it added to the difficulties of medical officers who were trying to establish hospitals in the field. For a time after the fighting stopped they lacked an adequate supply of tents and were forced to use any buildings they could find. They even had to leave some patients out in the open, where heavy rains added to their sufferings. Hospitals were often moved; one group was flooded out from a low-lying area that was otherwise both safe and convenient, and others had to be abandoned because of enemy fire. Some of these facilities apparently served only as clearing stations, and ambulances might have to move patients twice, even when the original hospital was not abandoned.28

The burden on Union surgeons at Gettysburg was great. Although Sanitary Commission supplies met their most basic needs until Medical Department wagons could arrive, medical officers were not always able to keep up with their case loads. Some had to work through the night and well into the next day. As a result of the strain, many fell ill at one time or another. Those who were captured with their patients were forced to work with few medicines or instruments after their Southern counterparts helped themselves to Union supplies. In addition, thirteen Union surgeons were wounded at Gettysburg, and one died as a result of his injuries.

One severely wounded patient who did not lack for attention from Union surgeons was Maj. Gen. Daniel Sickles, who managed to separate himself from his cigar long enough to have his right leg amputated at the thigh in a field hospital at Gettysburg. Immediately after the surgery, the medical director of the III Corps and forty soldiers accompanied the general while he was carried on a litter to a distant railroad depot. The surgeon remained with him for the rest

27Duinell Medical Report, Ms C 129, NLM; Richard H. Shryock, "A Medical Perspective on the Civil War," Medicine in America: Historical Essays (Baltimore: Johns Hopkins Press, 1966), p. 91.
28Duinell Medical Report, Ms C129, NLM.


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of his trip to Washington, where Sickles recovered from his wound and his leg joined the growing collection at the new Army Medical Museum.29

In spite of the large numbers of both Union and Confederate wounded remaining in the Gettysburg area, Meade found it necessary to take most of his 650 medical officers with him as he started his pursuit of Lee on 6 July. Only 106 Union surgeons remained behind, an average of 1 for every 150 patients. Since some of the Confederate physicians left behind with their wounded had apparently deserted their charges, Letterman was forced to ask Hammond to send 20 more surgeons to Pennsylvania. The strain on Union physicians was great. Young John Shaw Billings wrote his wife on 9 July that he was "covered with blood" and "tired out almost completely," able "only [to] say that I wish I was with you tonight and could lie down and sleep for 16 hours without stopping." He added that he had been "operating all day long and have got the chief part of the butchering done in a satisfactory manner."30

By mid-July the surgeons Letterman had requested arrived. Some private physicians from neighboring states came to help, but most were of little use, preferring to operate rather than to help wherever they were needed. Letterman, who accompanied Meade, also asked Hammond to send surgeons to join the Army of the Potomac on its march, to make up for those left behind at Gettysburg. An additional forty-seven medical officers reported to Letterman on 9 July.31

As rapidly as possible, the Medical Department shipped its patients from Gettysburg to general hospitals in the north. Hammond ordered that a medical officer "of experience" be found to coordinate the evacuation. Those remaining at Gettysburg were from both Union and Confederate armies, usually amputees or those with se-rious wounds. As the number of patients dwindled, surgeons attempted to consolidate them and near the end of July opened a new 1,200-bed tent hospital, dubbed Letterman Hospital or Camp Letterman, for their use. The new facility was near the railroad so that patients being sent north could be moved to their trains by litter. Although the presence of individual citizens anxious to help the wounded added a note of confusion to the facilities at Gettysburg, the Sanitary Commission and other volunteer agencies helped staff and supply Gettysburg hospitals, including Camp Letterman, which remained open until 20 November.32

Evacuation from Gettysburg hospitals was initially slower than expected, since few ambulances remained after Meade's departure. Before Camp Letterman opened near the station and until the Sanitary Commission opened a 150-bed depot, many patients were left lying in the open, exposed to the weather as they waited for a train. The train trip from Gettysburg was also an ordeal. The rail line was in poor condition, with its bridges in particularly bad shape. Although the department

29W. A. Swanberg, Sickles the Incredible (New York: Charles Scribner's Sons, 1956), pp. 216-21, 405 n. 16.
30Quotes from Ltr, Billings to his wife (9 Jul 1863), in John Shaw Billings, A Memoir, ed. Fielding H. Garrison (New York and London: Knickerbocker Press, 1915), p. 65; Ltr, Swift to SG (18 Jul 1863), RG 112, entry 12.
31Ltr, Swift to SG (18 Jul 1863), RG 112, entry 12.
32Quote from Ltr, Hammond to R. Smith (9 Jul 1863), RG 112, entry 12; Duinell Medical Report, Ms C129, NLM; Ltr, Goodman to McNulty(13 Aug 1864) and Orders, Goodman (28 Jul 1863), both in Ms fB50, NLM; Maxwell, Sanitary Commission, pp. 212-13; Olmsted, "Preliminary Report," p. 50; Ltr, a surgeon at Camp Letterman to Steiner (copy, 21 Sep 1863), in Steiner Report, Ms C 19, NLM; Anna Morris Holstein, Three Years in Field Hospitals of the Army of the Potomac (Philadelphia: J. B. Lippincott, 1867), pp.43-44,49-51.


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GENERAL HOSPITAL AT GETTYSBURG. (Courtesy of Library of Congress.)

placed a surgeon and attendants on every car that carried patients, most of the wounded were in boxcars belonging to returning supply trains rather than in cars designed especially for their comfort. Patients had only straw or hay for bedding, but for longer trips they were supplied with urinals, bedpans, water coolers, and other conveniences. The department eventually evacuated an average of 800 men a day from the Gettysburg area northward.33

Because of factors beyond the control of either Letterman or the Medical Department, the death rate among the wounded after Gettysburg was unusually high and the wounds were unusually severe. The men had been exhausted even before the battle by their long, fast march in the heat. After they were injured, many suffered further from exposure to the elements, even though the wounded among both Union and Confederate prisoners were dressed and under shelter of some kind within twenty-four hours of the end of battle. (The British took ten days to reach this point after the battle of Waterloo.) The Medical Department's achievements under adverse conditions illustrated once more the success of Letterman's approach to the problems involved in evacuating and caring for the wounded from a large modern army.34

The army Letterman served was large and moved relatively long distances by land. The surgeons who participated in the July 1863 attempt to take Charleston, South Carolina, by an attack from the ocean found an entirely different challenge. Because the troops involved were moving from one island to another, the Medical Department had to make extensive use of

33Fatout, Letters, p. 70; Maxwell, Sanitary Commission, p. 212; Duinell Medical Report, Ms C129, NLM; MSH 2, pt. 3:959.
34Duinell Medical Report, Ms C129, NLM; S. Weir Mitchell, "Medical Department in the Civil War," Journal of the American Medical Association 62 (1914):1447.


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JOHN CRAVEN OPERATING during siege of Battery Wagner. (Courtesy of Massachusetts Commandery Military Order of the Loyal Legion and the U.S. Army Military History Institute.)

boats to transport men, ambulances, and supplies. On 8 July immediately after the attack began, John J. Craven, the volunteer surgeon serving as medical director for the expedition, loaded ambulances and tents on the ferry that left Folly Island, where a hospital had been established, for Morris Island, where Union forces were besieging Battery Wagner, and where Clara Barton helped care for the hospitalized. The first field hospital that he established on Morris Island had to be moved once to avoid fire from Fort Sumter. His patients were evacuated by ambulance across the hard sand to the hospital and later by ferry to the facility on Folly Island. When more than 1,200 casualties resulted from a second attack on Battery Wagner on 18 July, Craven decided to move all the wounded from Morris Island by steamer back to hospitals at Hilton Head and Beaufort, South Carolina, which he did in two days with the help of three naval medical officers and a physician from the Sanitary Commission. When arrangements for an exchange of wounded prisoners were complete, Craven went by steamer from Morris Island back to Hilton Head to pick up thirty-nine wounded Confederate soldiers. Meeting a Confederate vessel in Charleston Harbor, he exchanged his prisoners for about half of the Union wounded in enemy hands, 105 officers and men, whom he sent back to Hilton Head.35

35MSH 1, app.:241-42; WOR, ser. 1, 28, pt. 2:10; "Report on the Sanitary State of the Troops at Charleston," USSC Sanitary Bulletin 1(1866):81; Ishbel Ross, Angel of the Battlefield (New York: Harper & Bros., 1956), p. 62.


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Among the difficulties Craven experienced while on Morris Island was insubordination. During the siege of Battery Wagner, a volunteer surgeon openly defied Craven's authority. Even after the medical director of the Southern Department ordered him to obey Craven, the surgeon continued to set up hospitals for his men wherever and whenever he chose, but whether disciplinary steps were ever taken against the miscreant is not known. During the rest of the summer until the enemy abandoned Battery Wagner in September, Craven also encountered both malaria and scurvy. In the end, however, the efforts of the expedition were frustrated, and as 1863 ended Charleston remained in Confederate hands.36

Although reports of scurvy from Union held areas along the southern coastline were not frequent, fevers continued to be very common. Soldiers in the New Orleans area were hit hard by "swamp fever," or typhoid; an officer under Butler wrote of hearing "the screams and howls of the patients in their crazy fits" in a hospital half a mile from camp and noted that two-thirds of his regiment were dead or hospitalized. Fortunately, Union surgeons were prepared to treat malaria and took the problems it caused in stride. The mortality from malarial fevers was not high in proportion to the number of cases, but in the late summer and early fall, as many as half of the soldiers in some commands were off duty at one time because of these fevers, despite some use of whiskey and quinine or a related drug as a prophylactic. The men assigned to work along the railroad from New Bern to Morehead City in North Carolina, for example, frequently fell ill, and those at two stations along the line had to be relieved every ten days as a result. Each regiment in North Carolina had its own hospital, but the Medical Department established general facilities in New Bern, Morehead City, and Beaufort to handle serious and chronic cases and to supply medicines to a growing number of former slaves working for the Union, as well as for their families.37

Care of the Sick and Wounded in the West

Just as Meade was turning back Confederate forces at Gettysburg, Grant was accepting the surrender of Vicksburg, Mississippi, after a campaign that lasted six months. Grant's drive on the southern city, however, involved many lesser engagements rather than one or two great battles.

Working under Grant for this campaign were three Army corps, one of which, under Maj. Gen. William T. Sherman, set an example for the others in the management of the sick and wounded, while a second, under Maj. Gen. John McClernand, particularly needed to improve in this regard. McClernand was more of a politician than a soldier and, like Buell before him, tended to neglect his sick and wounded, leaving them behind without supplies or attendants and, on at least one occasion, without ambulances as well. Despite rough terrain and poor roads, the ambulance system in

36Strong, Diary, p. 350; MSH 1, app.:241; "Report on the Sanitary State," USSC Sanitary Bulletin 1 (1866):78, 81.
37John William DeForest, A Volunteer's Adventure, a Union Captain's Record of the Civil War, ed. James H. Croushore (New Haven, Conn.: Yale University Press, 1946), p. 152, quotes from p. 153; MSH 1, app.:238-39; Ltrs, F. G. Snelling to SG (10 and 15 Jan 1863), both in RG 112, entry 12.


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Sherman's IV Corps, which was basically that created by Letterman, was so effective that Medical Inspector Edward Vollum persuaded Grant to adopt it for his entire army. After March 1863, therefore, Grant's ambulance corps was organized by division, with a commissioned officer commanding each unit at the division level, a noncommissioned officer in charge of each at the brigade level, and one driver plus two enlisted men assigned to each ambulance.38

Just at the time Vollum persuaded Grant to adopt Sherman's ambulance plan for the entire Army of the Tennessee, a new medical officer, Madison Mills, a Regular Army surgeon, arrived to replace volunteer surgeon Hewit as medical director. Hewit had already established a base hospital at Milliken's Bend, northwest of Vicksburg on the Mississippi. Now Mills created a fieldhospital system for the troops taking part in the campaign, one that was designed to accommodate Grant's desire to keep as many of his sick and wounded as possible within his department. Mills also established both convalescent camps and corps facilities to supplement field hospitals at the division level, so that only the seriously incapacitated would need to be taken to distant general facilities.39

Mills' work was complicated by the fact that various units of the Union's Army of the Tennessee were moving about the countryside on either side of the Mississippi River as Grant attempted to close in on Vicksburg. In some instances, Union forces made no attempt to hold ground previously taken, and any wounded not moved with their units found themselves within the enemy's lines. Every effort was made to keep with the army both casualties and those who fell ill in increasing numbers, but eventually more than 2,000 were left behind.40

FORMER SLAVE, one of the Medical Department's patients. (Courtesy of Massachusetts Commandery Military Order of the Loyal Legion and the U.S. Army Military History Institute.)

For an army so much on the move, the muddy roads and flooding streams of springtime made supply difficult, and the carelessness of some surgeons in making timely requisitions made matters worse. The U.S. and Western Sanitary Commissions provided supplies when the government was unable to furnish them and continued to help in the evacuation of pa-

38 MSH 2, pt. 3:398; Duncan, Medical Department, pt. 3, p. 14; Joseph E. King, "Shoulder Straps for Aesculapius: The Vicksburg Campaign in 1863," Military Surgeon 114 (1954):218-19.
39MSH 1, app.:331; WOR, ser. 1, 24, pt. 3:128.
40WOR, ser. 1, 24, pt. 3:357; MSH 1, app.:334; USSC, Documents 2, no. 75:3.


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EDWARD VOLLUM. (Courtesy of National Library of Medicine.)

tients, but again commanding officers were tempted to lighten their burdens by leaving regimental medical needs behind. Letterman's organization of supply by brigade had apparently not been adopted in Grant's army, but Mills personally, as medical director for the entire army, took an extra supply of medicines, bandages, and similar items with him. He supplemented these, where possible, by what he could find at drugstores in the communities through which the troops moved. In March Sherman, then on the far side of the Mississippi from Vicksburg and to the west of that city, was confident that his field hospitals were amply supplied. He deplored the spreading of rumors to the contrary. It may have been these very rumors, however, that led Hammond to seek permission to travel west on an inspection tour, even though Grant's army, once it was relatively stationary near Vicksburg, was easily supplied. Steamers made the round trip from Memphis in four to five days, and the Medical Department's needs were stockpiled at Young's Point, north of Vicksburg, where one vessel had been assigned to pick them up and deliver them wherever they were needed.41

Supply problems may have been few after May, but the surrender of Vicksburg on 4 July did not end the difficulties facing the Medical Department of Grant's army. As many as 6,000 or 7,000 Confederate wounded, most in very bad condition, depended on Union physicians for aid. The Sanitary Commission once again assisted the Union medical officers. A call also went out to the chief quartermaster for the Department of the Tennessee to assign someone at once specifically to obtain the tents and buildings needed for hospitals, to arrange for transportation, and to provide the wood, water, and other items needed by the Medical Department in Vicksburg. Men whose recovery would be prolonged or who would never completely recover from their wounds were evacuated from the Vicksburg area after the siege. The hospitals near the city that served these patients were consolidated into one, where men awaiting evacuation could receive temporary care. Each regiment also had its own hospital, located when possible in buildings once used by the Confederates for this purpose, where those with tem-

41MSH 1, app.:330-32; WOR, ser. 1, 24, pt. 3:357; Forman, Western Sanitary Commission, p. 77; Ltr, Brown to SG (comment of approx. 20 Aug 1863 by unknown author, 9 Aug 1863), RG 112, entry 12; J. S. Newberry, "What the U.S. Sanitary Commission Is Doing in the Valley of the Mississippi," Sanitary Reporter 1 (1863): 1; S. B. Thrall, "An Iowa Doctor in Blue: The Letters of Seneca B. Thrall, 1862-1864," ed. M. Throne, Iowa Journal of History 58 (1906):128, 130.


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porary ills or slight wounds could receive care.42

At Memphis, many of the patients evacuated from Vicksburg went upriver, where they were joined by some of the more seriously sick and wounded from facilities serving Union forces fighting a successful campaign in Arkansas. The path of evacuation from Arkansas to Memphis was not as well planned as that from Vicksburg, however. The Arkansas evacuees' boats were crowded and their accommodations drafty and so inadequate that patients had to lie on the deck. In late summer the sickness and mortality rates were high in the 20,000-man Army of the Arkansas as it worked its way toward Little Rock. The medical staff caring for those remaining with that army was small, and some physicians were incompetent. Supplies, which had to be shipped from Memphis, came in slowly until the very end of the year. With so many difficulties involved in caring for patients in Arkansas, it is not surprising that almost 1,200 were sent to Memphis. To care for the patients coming from Arkansas and Vicksburg, the Medical Department in Memphis took over the largest and finest buildings they could locate, many of which were hotels, until they had space for 5,000 beds. By summer, however, all these hospitals were full, and patients from Vicksburg were being sent to such cities as Cincinnati and St. Louis.43

MADISON MILLS. (Courtesy of National Library of Medicine.)

While Grant was planning his effort against Vicksburg in early 1863, the Army of the Cumberland under Rosecrans, with its 4,000 wounded, was recovering from the battle of Murfreesboro and preparing for a new campaign that was not actually undertaken until the summer. Although the town itself, built on a rock, stank with the effluvia of shallow privies as the weather became hotter, the hospital was reportedly immaculate. By spring it could boast of a fine garden; a visitor in early June described that facility as "one of the brightest spots in the Department of the Cumberland.... a model army hospital." Meanwhile, Rosecrans and his medical director

42WOR, ser. 1, 24, pt. 1:489-90; H. A. Warriner, "Department of the Tennessee," "The Rebel Sick and Wounded at Vicksburg," "Dr. Fithian's Report," and "Department of the Tennessee- Report of Dr. Fithian," all in Sanitary Reporter 1 (1863):45, 52, 59-60, and 74, respectively.
43Forman, Western Sanitary Commission, pp. 69-70; MSH 1, app.:331; J. R. Smith, "Army of the Arkansas," Ms C126, NLM; Paul E. Steiner, Disease in the Civil War- Natural Biological Warfare, 1861-1865 (Springfield, Ill.: Charles C Thomas, 1968), p. 30; William Fithian, "Affairs at Helena," "Letter From Dr. Warriner," and "Letters," all in Sanitary Reporter 1 (1863):21, 62, and 63, respectively.


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used the period of inactivity to have a board check into the competency of his medical officers, some of whom proved less than satisfactory.44

Rosecrans' new campaign, aimed at the capture of Chattanooga, a vital railroad junction, would try his medical officers to their utmost. Handicapped by mountainous terrain, vulnerable lines of communications, and an unexpected but severe defeat, they were fated to see their patients suffer from exposure both on the battlefield and during evacuation, from capture by the enemy, and from the effects of near starvation. In May, however, the availability of ripe blueberries and green corn in the fields was accompanied by a drop in the disease rate from 5 percent to 4 percent, where it remained until after the battle of Chickamauga, despite the wet weather that plagued the army on its march.45

Rosecrans' new medical director, Glover Perin, believed himself adequately prepared for the campaign when each regiment was supplied with all he estimated it could need for three months-like Madison Mills in Grant's army, he did not change to a system of supply by regiment. Perin planned to leave items held at the corps level intact as a reserve. Unfortunately, in at least some instances, amounts allowed were insufficient for the eventual need. He also did not follow Letterman's example by consolidating small hospitals, and unlike Mills, apparently accepted the ambulance system as he found it. He personally preferred Letterman's approach, however, since better control could be exercised over ambulance trains by having commissioned officers in charge of them. Perin also noted that no one was detailed in Rosecran's army to place patients into the ambulances and that these vehicles were still under the quartermaster's control. Their number was adequate, but since ambulances had been often used as baggage wagons during the winter and spring, many were in poor repair just when they were most needed. Each regiment in the Army of the Cumberland was accompanied by its own ambulance and hospital wagons, while a thirty-vehicle train also moved with each division.46

Perin was also able for a time to rely on two specially equipped railroad cars for the evacuation of his wounded, but an accident destroyed one and damaged the other sometime during the spring or summer, forcing medical officers to evacuate their wounded, as many as 100 a day, in boxcars. Evacuation by rail, furthermore, could not always be relied on because of the ease with which lines could be cut and because a portion of the line west of Chattanooga to Murfreesboro ran through enemy-held territory.47

A network of hospitals behind the front lines with their field hospitals awaited those who fell ill or were wounded during Rosecrans' advance or in the battle of Chickamauga. The principal facilities were in Nashville, where a group of highly regarded general hospitals provided 3,000 beds for soldiers and apparently more

44Quote from M. L. Read, "Department of the Cumberland," Sanitary Reporter 1 (1863):27; WOR, ser. 1, 20, pt. 1:220; USSC, Sanitary Memoirs, p. 55; Ltr, Lewis W. Leeds to Letterman (25 Jun 1863), RG 112, entry 12.
45Read, "Cumberland," and "Condition of the Army," both in Sanitary Reporter 1 (1863):27 and 2 (1864):152, respectively. Unless otherwise indicated, material on the Army of the Cumberland is based on MSH 1, app.:266-68, 70, and Duncan, "The Great Battle of the West- Chickamauga," in Medical Department, pt. 8.
46USSC, Surgical Memoirs 1:54.
47"Hospital Cars- Report of Dr. Barnum" and "Report of Dr. Read," both in Sanitary Reporter 1(1863):58 and 59, respectively.


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for sick and wounded former slaves who were working for the Army. Louisville and other cities offered another 12,000 spaces. Attempts were made in the summer of 1863 to vacate beds in Nashville, but although more than 2,000 casualties were sent to Louisville and thence to facilities nearer their homes, still others came in from Rosecrans' army to take their places. Hospitals in Murfreesboro were also emptied of their patients, to the extent possible, so that they could be used for the casualties of the campaign. A 1,500-bed mobile tent hospital was left behind in Murfreesboro, organized and equipped so that it could be moved as needed. In August it joined other facilities located along the Tennessee River and the nearby railroad that were used as temporary shelters for soldiers from Rosecrans' army. When possible, these hospitals as well as the convalescent camps that were located along the route were sheltered in buildings or in tents abandoned by the Confederates.48

When Rosecrans' men reached Chattanooga, newly abandoned by the Confederates as they evaded Union efforts to cut them off, Perin attempted to set up hospital accommodations for as many as 3,000 men, but found space for only 500 beds in those buildings originally used by the enemy for the same purpose. These structures, furthermore, were far from ideal; many lacked both doors and windows. Nevertheless, Perin urged that the sick and wounded from Rosecrans' army be sent to Chattanooga before the impending battle so that field units would not be unnecessarily encumbered.

In the field at Chickamauga, where Rosecrans finally met the enemy, medical officers experienced all the difficulties spawned by defeat, including the necessity for moving hospitals and the inevitable capture of many of their wounded. Perin has been criticized for locating most of the division hospitals in an area far from the battlefield and easily cut off by the enemy. He has also been blamed for not moving these units and their occupants as promptly as possible when they were in danger of capture. The site he chose, however, was near a vitally needed source of water. Since predicting the fortunes of this battle was particularly difficult and the area was "undulating and thickly timbered," evacuation was tedious and time-consuming. As many as 2,500 wounded were taken captive, 2,000 of whom had been left on the field on 20 September when the army fled, but 1,700 were soon exchanged.49

At Chattanooga, the Medical Department was once again not prepared to handle the number of wounded that flooded into the city. With the aid of the Sanitary Commission, Perin tried to find shelter for the 9,000 wounded. More than 200 bales of cotton that were discovered hidden in the town were rapidly converted into mattresses enough to accommodate all the additional wounded. Supplies sufficient to the needs of a hard campaign had not been accumulated, however, and food was scarce even before the defeat at Chickamauga, so that many patients arriving at the hospitals had nothing to eat for two days.50

48WOR, ser. 1, 23, pt. 1:418-19; J. P. Barnum, "The Hospital Train," "The Rev. Mr. Hoblitt on Nashville Hospitals," David Welsh, "Negro Hospital," "Hospital Cars-Report of Dr. Barnum," "Report of Rev. F. H. Bushnell-Louisville and New Albany Hospitals," "Report of Mr. Loomis," and "Report of Dr. Read," all in Sanitary Reporter 1(1863):25-26, 34, 5 1, 59, 77, 118-19, and 141, respectively; Ltr, Perin to G. Goddard (23 Feb 1863), RG 112, entry 12.
49Quote from MSH 1, app.:268; Rpts, Perin (22 Sep and 3 Oct 1863), both in RG 112, entry 12.
50Maxwell, Sanitary Commission, p. 214; USSC, Sanitary Memoirs, p. 16; "Report of M. C. Read," Sanitary Reporter 1 (1863):73-74.


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After the battle, attempts were made to move the wounded from the Chattanooga area, in the belief that the city might soon be captured. A new tent hospital was established across the Tennessee River to the north, but not enough tents were available to shelter all of the 2,000 sent there, forcing surgeons to turn to use "bowers of branches and leaves" to protect their patients from the weather. Many patients were sent west on an exceedingly arduous trip to hospitals nearer Murfreesboro. In this effort, Perin encountered a familar problem in the persons of malingerers and the slightly wounded, anxious to escape further action. Medical officers were set to watch for them at the pontoon bridges across the river. In the confusion, however, many who were not seriously hurt succeeded in joining the supply wagons that were laboring westward carrying the more seriously injured sixty miles to where the railroad to Nashville was still open.51

Despite inexplicable claims by a medical officer in Louisville that shipments were getting through to the Army of the Cumberland, there was no escaping the fact that Chattanooga was almost completely cut off from significant outside help. The river was not navigable near the city, the railroad led into enemy territory, and mountain roads had been rendered almost impossible by weather and enemy raids. By October, many of the horses that pulled ambulances were so starved that they were no longer useful, and although the Sanitary Commission stationed agents along the roads used in evacuation, their aid was also limited by transportation problems. The wounded in the city suffered from their inadequate diet and shivered as autumn chills deepened and fuel became scarce. Help was on its way, however. In late September trains began bringing Hooker with two corps from the Army of the Potomac to Bridgeport, Alabama, west of Chattanooga on the Tennessee River. In late October they finally opened the way from Chattanooga to the navigable part of the river, supplies could come through freely, and patients could be removed from the city without danger.52

By this point, Grant was in command of all forces in the West, and Sherman was on his way to Chattanooga from Memphis with two corps from the Army of the Tennessee. Sherman's men found all the food they needed in the countryside as they marched, and when they reached Chattanooga in late November, they were healthier than they had been in some time. While Sherman was marching west, medical officers in Chattanooga were preparing for the battle they knew would come, laying in new supplies and readying hospital buildings in anticipation of as many as 5,000 casualties.

During the battle to lift the siege of Chattanooga in late November, by which time Maj. Gen. George H. Thomas had replaced Rosecrans, ambulances were able to come closer to the battlefield than before because the terrain tended to shield them from enemy fire. The 60,000-man Union force was victorious, and it was now the enemy who fled. Ambulance trains could function effectively, and there was no need to move field hospitals repeatedly. Tents were still scarce within the city, but lumber from nearby buildings was used to make temporary shelters and new bunks. With few exceptions, all casualties were soon "comfortably housed."53

51Quote from MSH 1, app.:288; Huston, Sinews, p. 233; USSC, Sanitary Memoirs, pp. 60-61.
52USSC, Sanitary Memoirs, pp. 16, 60-61; Ltr, Shumard to Hammond (1 Oct 1863), RG 112, entry 12.
53Quote from MSH 1, app.:290.


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Unfortunately, the crowding of patients, many still debilitated, into hospitals in Chattanooga led to the rapid spread of infection among them. Patients in the division hospitals located for twenty-five days in tents outside the city did not develop gangrene, even when it appeared in a large percentage of amputation stumps in hospitals within the city. The weather made evacuation inadvisable, thus precluding an early end to the overcrowding. It was only in January that trains could again travel to Nashville, carrying the wounded from Chattanooga.54

Perin's organization of the Medical Department in Rosecrans' army was not as efficient as that of Letterman, but the basic reason for the suffering of the wounded from exposure, crowding, and deprivation lay not in Perin's management but rather in the nature of the campaign. Supply lines were unusually vulnerable, and the defeat at Chickamauga resulted in a rout and almost complete isolation. Neither the supply situation nor the shortage of beds would have been serious had medicines, food, and hospital stores come in freely and had patients been evacuated as soon as they could be moved.

Conclusion

Although Union victories in 1863 in some instances simplified the evacuation and immediate care of the wounded soldier, even success in battle could not eliminate difficulties caused by lack of hospital space, nor could Medical Department attempts to emphasize the importance of what the soldier ate guarantee that diet would receive the serious consideration it deserved from officers commanding troops. The effects of underestimating casualty rates were worsened by the reluctance of commanding officers to complicate the marches and maneuvers of their armies by bringing along many wagons loaded with tents and other department supplies. Large-scale prevention of contagious disease was not yet possible, and the casual attitudes of line officers at all levels undermined attempts to improve the Army's health through greater attention to diet. Further improvement in the Army's health and in the care of the wounded would depend upon greater cooperation between all those responsible either directly or indirectly for the welfare of the Union soldier.

54"Report of Dr. Read," Sanitary Reporter 1 (1863):142-43; USSC, Sanitary Memoirs, p. 61.